Reference no: EM133250151

Cushing's Syndrome Next Gen:

It is Wednesday afternoon (Time 1215), and you are working in a busy Emergency Department

You are caring for Joy, a 39-year-old female. She arrived at the emergency department with her spouse, John. She complains of shortness of breath and lethargy. She reports her breathing is worse in the evening and resolves when she wears her CPAP for bedtime. She is afebrile and appears well kept. The breathing problem started yesterday, but she has been "tired" for weeks now.

Social History (from Joy and John) Joy is a bus driver who works 9 months out of the year. She enjoys her job and has been a bus driver for 7 years. She has a sedentary lifestyle and eats fast food 6 days a week. Joy and John make a "home cooked" meal on Sundays. Her BMI is 36. Joy states that she has been "heavy" her entire life, even as a child. She reports sleeping 6-8 hours a night on average, but still feels tired in the morning. She does not enjoy doing things she once enjoyed. She denies illicit drug use, alcohol, and tobacco. She schedules an annual checkup once a year but has not gone to the appointment yet. Her spouse reports that she always goes to her appointments and takes her medication as prescribed so he "doesn't know why she is sick?". She checks her blood pressure and blood sugar every day and says it is "always high even if I take my medicine". She admits that she feels short of breath when the weather begins to change, which it did yesterday.

Medical: Amenorrhea, morbid obesity, OSA, HTN, COPD, Asthma, and Dyslipidemia.

Subjective History: (from Joy): Joy was born and raised in Oklahoma. She enjoys her career and plans on retiring with the school district as a bus driver. Joy has always been overweight, even as a child. John reports that her face has gotten more "round" this year, but he thinks that she looks "healthy" otherwise. Joy has noticed that she has progressively felt unwell over the past year. She reports feeling tired and more "depressed" this year. She has noticed that her skin has changed and bruises easily but does not remember how she injured herself. Her last COPD exacerbation was 5 months ago. She has a decreased libido which has caused issues in her marriage. She lives in an apartment with her husband on the second floor and has trouble climbing stairs.